Hormone Imbalance Test for Women

INTRODUCTION

Menopause is defined as the time in a woman’s life, usually between age 45 and 55 years, when the ovaries stop producing eggs (ovulating) and menstrual periods end. After menopause, a woman can no longer get pregnant.

Menopause does not happen suddenly; most women experience several years of changes in their menstrual periods before they stop completely. During this time (also called the menopausal transition or “perimenopause”), many women also start to have menopausal symptoms. These result from declining levels of estrogen in the body and can include hot flashes, night sweats, mood changes, sleep problems, and vaginal dryness. A woman is said to have completed menopause once she has gone a full year without having a period. The average age for a woman to stop having periods is 51 years.
During the transition to menopause, the ovarian production of estrogen decreases by more than 90 percent. The decrease in ovarian estrogen production is what leads to the typical symptoms of hot flashes, night sweats, and vaginal dryness. Some women experience an increase in anxiety and depression during this transition, especially those who have previously experienced these symptoms. Sleep problems are also common at this time. There are a number of options available to ease the symptoms of menopause, including estrogen and nonhormonal options. Testosterone levels also decrease with aging. This article explains how estrogen, progesterone, and testosterone works and discusses the risks and benefits of bioidentical hormone therapy. Information about nonhormonal treatment options is available separately as well.

WHAT is MENOPAUSAL THERAPY?

Menopausal hormone therapy is the term used to describe the two hormones, estrogen and progesterone. The synthetic progesterones such as Progestin, are also frequently given but have increased risks. Testosterone is the most common hormone in women as in men (although men have a much higher concentration). These hormones are given to relieve bothersome symptoms of menopause. Estrogen is the hormone that relieves the symptoms. Women with a uterus must also take progesterone to prevent uterine cancer. This is because estrogen alone can cause the lining of the uterus to overgrow (potentially leading to uterine cancer).

Women who have had a hysterectomy do not have a uterus and cannot develop uterine cancer. These women can be treated with estrogen alone but again a mixture of all three is probably best for most women. Your body made all three hormones from the start of menses in your teens to menopause in your 40s or 50s.,

Types of estrogen — Estrogen is available in many different forms. Again biologically identical estrogen such as estradiol (most common form of natural estrogen in women) is considered the most therapeutic and safest compared to synthetic estrogens or estrogens from animals (Premarin from pregnant horse urine). For hot flashes, it can be taken as a transdermal patch (worn on the skin), an oral pill, or a “ring” or tablet that is inserted into the vagina. There are also creams and sprays that can be put on the skin.

In the past, most women were prescribed conjugated estrogens, but now the preferred estrogen is estradiol. The standard dose of oral estradiol is 0.5 or 1.0 mg daily by mouth. Lower doses seem to have fewer side effects and probably help to minimize risks. Estradiol is the estrogen that is identical to the one the ovary makes throughout reproductive life. Estradiol can be given by mouth, skin patch, or vaginal ring.

Estrogen patch — Many experts now prefer treating women with the estradiol patch rather than estrogen pills (topical estrogen is associated with a very low to no risk of blood clots than estrogen pills). Combinations of estrogen and progestin patch (synthetic and not recommended) are also available. Estrogen patches work as well as estrogen pills to increase bone density and treat menopausal symptoms. Women with a uterus who use an estrogen patch must also take a progestin to decrease the risk of uterine cancer.

Estrogen pill — There are many types of estrogen pills. Bioidentical estradiol (derived from plant sources or made) is the same estrogen that the ovary makes before menopause. Another commonly used estrogen, called Premarin (conjugated estrogen), is made from the urine of pregnant horses (mares). All types of estrogen can help to relieve menopausal symptoms. Combination pills that include both estrogen and progestin (not recommended) are available.

Low-dose birth control pill — Very low-dose birth control pills are a good option for women in their 40s who have bothersome hot flashes, irregular bleeding, and who still need a reliable form of birth control. Extreme caution should be used for women over 40 years who are also obese because of the higher risk of blood clots. Birth control pills are generally not recommended for postmenopausal women, because the dose of estrogen is higher than needed to relieve hot flashes.

Vaginal estrogen — Women with vaginal dryness can also be treated with very low doses of estrogen that treat the dryness but not hot flashes (because the dose is too low to get into the bloodstream). Vaginal estrogen comes in a cream, vaginal ring, or vaginal estrogen tablets. The low-dose vaginal estrogens do not usually require the use of a progestin pill.
Types of progesterone — Postmenopausal women with a uterus who are treated with estrogen alone have an increased risk of developing uterine cancer and hyperplasia (a precursor to uterine cancer). Taking a natural progesterone or a synthetic progestin will minimize this risk.

● Oral progestins – One commonly prescribed progestin pill is medroxyprogesterone acetate. Other types of synthetic progestin pills are also available. Many experts now treat the majority of their menopausal patients with natural progesterone rather than synthetic progestins. Natural progesterone has no negative effect on lipids and is a good choice for women with high cholesterol levels. In addition, natural progesterone have other advantages.
● Intrauterine progestin – An intrauterine device (IUD) is a form of birth control; one type, the levonorgestrel IUD (sample brand names for larger IUD devices: Mirena, Liletta.

Types of Testosterone — Topical testosterone as creams or gels or as pellet implants are available for women.

“Natural” or “bioidentical” products — Many women are turning to “natural” or compounded “bioidentical” hormone therapy as an alternative to conventional hormones for treating symptoms of menopause. The “bioidentical” approach uses an individualized dose of hormones that is made by a pharmacy as pills, creams, or vaginal suppositories. Since natural hormones cannot be patented for sale, some natural hormones are less likely to be produced by the pharmaceutical industry.

The hormones most commonly included in bioidentical products are estradiol, estrone, estriol, progesterone, testosterone, and dehydroepiandrosterone (DHEA). You may be asked to provide a saliva or blood sample to measure your baseline hormone levels. Based upon the results, the prescriber selects the individual hormones and doses.

The quality of these products is not as well regulated by the US Food and Drug Administration (FDA). The dose of hormones can vary from batch to batch. It is best to obtain your bio-identical hormone products from a reputable pharmacist or pharmaceutical company that has good quality control measures in place.

RISKS and BENEFITS of HORMONE THERAPY

The Women’s Health Initiative (WHI) was a large study designed to find out if hormone therapy would reduce the risk of heart attacks (coronary heart disease [CHD]) after menopause. The study found that taking estrogen-progestin in combination actually increases the risk of heart attacks, breast cancer, blood clots, and strokes in older postmenopausal women but not in younger postmenopausal women. However there were many flaws in this study.

The recommendations on the use of hormone replacement therapy are evolving. Supporters of this approach claim that bioidentical hormones are safer and have fewer side effects than commercially available synthetic preparations. There is already a large body and a growing body of scientific articles to support this approach.

Estrogen

Estrogen is a hormone found naturally in the human body, both in women and in lesser levels in men. A hormone is a chemical made by cells in your body that travel through the body to affect other cells.

Estrogen is made in the adrenal glands on top of the kidneys in both men and women. Women also make estrogen in the cells of the ovaries and some in breast tissue.
As women age there production of estrogen diminishes due to normal age related changes, genetics and as the outcome of certain disease processes. As this decline occurs the symptoms of menopause begin such as hot flushes, vaginal dryness, urinary stress incontinence, temperature regulation issues, dizziness, fatigue, irritability, and sweating. Other less obvious processes begin with this decline such as loss of estrogen’s protection against heart disease, stroke, osteoporosis, Alzheimer’s disease and memory disorders.

Replacement begins at menopause or surgical menopause although some symptoms can be relieved in “pre” and “peri” menopausal women.

Replacement is focused on prescribing Estradiol 2 (E2) as that is the primary form of estrogen that provides symptom abatement and long term protection.

In order to customize the estrogen replacement specific to you, we will measure your current level of estrogen and will review your symptoms of possible estrogen depletion. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend over time your estrogen levels (E2) with your response to treatment by following your symptoms of estrogen depletion until you are in proper balance.

We will continue to monitor you to minimize any possible side-effects from too little or too much estrogen and monitor you for any other related medical problems.

Estrogen Therapy in Women

BREAST CANCER: Estradiol alone does not increase breast cancer risk. No randomized control trials have ever shown an increase in breast cancer by estradiol. In addition, there is research showing that women diagnosed with breast cancer while taking hormone replacement therapy (HRT) have been reported to have a better prognosis, regardless of what stage their cancer was in, than women diagnosed in the absence of HRT.

UTERINE CANCER: Estradiol alone does ↑ uterine cancer. Estradiol induces endometrial proliferation. Full protection from uterine cancer is only provided by continuous use of and not cyclic progesterone.

DEEP VENOUS THROMBOSIS / Pulmonary Embolism: Transdermal estradiol does not increase risk of deep venous thrombosis / pulmonary embolism or women w/ risk factors such as high blood pressure, other cardiovascular risks factors. Premarin does increase risk of strokes, heart attacks, and blood clots. In patients with Factor V Leiden, transdermal estradiol is safe. Anyone regardless of hormone use can develop blood clots and the basal risk of deep venous thrombosis or embolism increases considerably with older age, from about 6/10,000 women/year at age 50 to about 60/10,000 women/year at age 80.

CARDIOVASCULAR DISEASE, STROKES, HEART ATTACKS: Oral estradiol does not increase the risk of stroke, heart attack, or cardiovascular disease even with advancing age. Premarin does increase risk of stroke, heart attack, andr cardiovascular disease. Estradiol cardio protective effect may be offset by the synthetic progesterones. There is increasing risk of stroke with age, with an 11 times increase in basal incidence from 50 – 54 years to age 65 – 74 years. Oral estrogen amplifies the stroke risk with increasing age. However transdermal estrogen does not increase the risk of stroke from baseline (compared to non-use).

In 1991, a New England Journal of Medicine editorial reported that a consensus of epidemiological studies had shown that women who are given postmenopausal estrogen have a 40% to 50% reduction in the risk of coronary artery disease in comparison with women who do not receive such therapy. In 2000, the Nurses’ Health Study reported that hormone replacement therapy (HRT) reduced the development of primary cardiovascular disease by nearly 40%. Bioidentical hormone replacement therapy is effective in reducing LDL (bad cholesterol), total cholesterol, and glucose, and in raising high-density lipoprotein levels (good cholesterol), these benefits did not result in a reduced incidence of cardiovascular disease in the older women, consistent with preexisting atherosclerotic disease in this population. HRT increases to activity of metalloproteinase that result is the softening of arterial plaque which is probably already established in the older age group.
COGNITION: There is no increased risk of cognitive impairment with estradiol use. This is not true with some of the other non-bioidentical hormone use.

GALLBLADDER DISEASE (GB): Oral estrogen does increase risk of GB disease. Transdermal estradiol does not increase risk of GB disease. Progesterone does not change risk.

HYPERTENSION: Contrary to oral estrogen, transdermal estradiol will not increase blood pressure. By means of 24-hr blood pressure monitoring in a randomized, double-blind protocol, it has been shown that transdermal estradiol significantly decreased 24-hr systolic as well as diastolic blood pressure and restored the normal amplitude of the circadian blood pressure rhythm in mildly hypertensive postmenopausal women.

OSTEOPOROSIS: Even in osteopenic patients, bioidentical hormone replacement therapy (HRT) decreases the risk of any type of fracture but this protection vanishes 2 years after withdrawal (with a 55% greater risk of hip fracture in those osteopenic patients who have stopped HRT than in those who continue to take estrogen). Estrogen (estradiol) decreases the risk of osteoporotic hip fracture by 25-50%. Given that alternative medications— bisphosphonates such as Fosamax, Actonel, and Boniva— offer a similar protective benefit but carry potential and real serious side-effects, many physicians recommend using hormones simply to prevent hip fracture.

Progesterone

Progesterone is secreted only by the ovary – therefore menopausal levels =0
• Excellent therapy for PMS- but only in high doses
• Excellent therapy for menopause
• It decreases headache and bloating associated with menstruation when used in high doses.
• Only treatment for perimenopause Natural progesterone (MP)(OMP) protects against uterine and breast carcinoma, osteoporosis, fibrocystic disease, ovarian cysts, CAD.
• Synthetic progestins (MPA) frequently cause bloating, headache, fatigue, weight gain, depression, increased symptoms of PMS by stimulating the estrogen receptor, CAD, CVD, DVT, PE, dementia, CA, DM
• Micronfzed progesterone (MP) is not associated with any of these complications
• In fact, progesterone does the opposite There are progesterone receptor sites in the uterus, breast, vagina, bloodvessels and brain.
• All menopausai women need progesterone, uterus or not
• All menopausai women must take progesterone for protection against breast
• All menopausai women must avoid progestins to avoid breast CA, CAD, CVD There are progesterone receptor sites throughout the body resulting in biologic effects
• Progesterone moderates many side effects of excess estrogen – reduces fluid retention, bloating, headache, bleeding, fibroids
« Progesterone is synergistic to estrogen’s effect on bone & lipids

Progesterone Therapy in Women:

BLOOD PRESSURE: Bioidentical Progesterone does have slight anti-mineralocorticoid properties lowering BP slightly.

BREAST CANCER: Provera (medroxyprogesterone) is mildly mitogenic on breast cells in synergism with estrogens (increases risk of breast cancer). Studies indicate that it is the loss of bioidentical progesterone that increases the risk of Endometrial / Uterine Cancer and Breast Cancer. Natural progesterone attenuates estrogen induced growth of female breast tissue. Use of natural estrogen and natural progesterone together will not increase the rate of breast cancer and in some studies actually lowers the risk of breast cancer.

UTERINE CANCE R: Higher the progesterone, the lower the risk of Breast Cancer or Uterine Cancer. 100mg of progesterone/d is not as protective as 200mg /d. Micronized progesterone is better absorbed through the gut than regular progesterone. Most women can tolerate micronized progesterone due to the first pass through liver effect. The few that do not can use the sublingual form. P4 up regulates nitric oxide synthetase activity in vaginal tissue contributing to lubrication & swelling, relaxation of vaginal smooth muscle, and stimulates GABA receptors with arousal motivation.
CV DISEASE: Progesterone inhibits arterial smooth muscle proliferation. Progesterone reduces foam cell proliferation and plaque formation. Effect is dose dependent. Progesterone reduces inflammatory cytokines (TNF).

Testosterone Therapy in Women: Facts based upon this and many other studies: ‘Testosterone Therapy in Women: Myths and misconceptions’ Maturitas 74 (2013) 230-234.
Testosterone is the most abundant and biologically active hormone in women.
Testosterone is essential for women’s physical and mental wellbeing.
Testosterone does not cause masculinizing effect on women or fetuses when use in normal levels.
Testosterone therapy increases scalp hair growth in women.
There is no conclusive evidence that testosterone therapy causes hoarseness or irreversible vocal cord changes in women.
There is substantial evidence that testosterone is cardio protective and that adequate levels reduces cardiovascular disease.
Non-oral testosterone does not adversely affect the liver or increase clotting factors.
Testosterone therapy decreases anxiety, irritability, and aggression.
Testosterone is breast protective and does not increase risk of breast cancer.
The safety of non-oral testosterone therapy in women is well-established, including long-term follow up.

WHO SHOULD TAKE HORMONE THERAPY?

The most common reason for taking hormone therapy is to treat bothersome menopausal symptoms, such as hot flashes or vaginal dryness. Most experts agree that hormone therapy is safe for healthy women who have menopausal symptoms. Most experts recommend that you taper and stop your hormone therapy after four or five years to avoid any increased risk of breast cancer. However, this can be a challenge for many women because the average duration of hot flashes is approximately seven to eight years.

The recommendations on the use of hormone replacement therapy are evolving. Supporters of this approach claim that bioidentical hormones are safer and have fewer side effects than commercially available synthetic preparations. There is already a large body and a growing body of scientific articles to support this approach.

Who should avoid hormones? — Hormone therapy is not recommended for women with the following:
● Current or past history of breast cancer
● Coronary heart disease
● A previous blood clot, heart attack, or stroke
● Women at high risk for these complications

ALTERNATIVES to HORMONE THERAPY

Non hormonal approaches are available and are often effective in relieving bothersome menopausal symptoms in many women.

Gabapentin — Gabapentin (sample brand name: Neurontin) is a drug that is primarily used to treat seizures. It also relieves hot flashes in some women, preferably given as a single bedtime dose or during the daytime as well.

Antidepressants — Antidepressant medications are recommended as a first-line treatment for hot flashes in women who cannot take estrogen. Paroxetine is the only drug approved in the United States for hot flashes in this class, but other antidepressant medications have also been used for hot flashes.

Plant-derived estrogens (phytoestrogens) — Plant-derived estrogens have been marketed as a “natural” or “safer” alternative to hormones for women with menopausal symptoms. Phytoestrogens are found in many foods, including soybeans, chickpeas, lentils, flaxseed, lentils, grains, fruits, vegetables, and red clover. Isoflavone supplements, a type of phytoestrogen, can be purchased in health food stores. In some studies the phytoestrogens have not helped to reduce hot flashes or night sweats.

Herbal treatments — A number of herbal treatments have been promoted as a “natural” remedy for hot flashes. But clinical trials have shown that it is not more effective than placebo.

Cognitive behavioral and other treatments — Stress management, relaxation, deep breathing, and yoga might be helpful for some women, but study results have been inconsistent.

TREATING VAGINAL DRYNESS

Low-dose vaginal estrogen is a very effective treatment for postmenopausal women with vaginal dryness or pain with intercourse. This is a treatment that women can continue for many years after menopause.


Women’s Health

At the Caudle Center, women’s health is important to us. We offer many different treatments/options to promote optimal women’s health outcomes. We offer a variety of services including, hormone replacement therapy, weight loss, vaginal rejuvenation, skincare, and an array of other services to provide a holistic approach to women’s healthcare. When you arrive at our facility, our providers will perform a consultation with you, and individualize a personal care plan to meet your women’s health needs.

At the Caudle center, we recognize that hormones are an important aspect to the overall health and wellbeing of women. Menopause can cause an array of symptoms including hot flashes, sleep disturbances, mood swings, painful intercourse, decreased vaginal secretions, thinning bones, changes in cognition, and many more. We realize that hormone replacement therapy is not a “one size fits all treatment”. This is why our providers work with you to personalize a treatment plan that meets your specific hormone needs based on your individual symptoms and lab work. For more information regarding our HRT services, please click here. (Insert hyperlink here to HRT landing page).

As many bodily changes occur due to the childbirth and aging processes, urinary incontinence is a common concern for many women. We offer a variety of options for women to address this issue including pharmacologic interventions, pelvic floor exercises, and radiofrequency treatments that can alleviate these symptoms. For more information regarding urinary incontinence, please click here (Insert hyperlink here to Votiva landing page).

We offer a variety of weight loss options ranging from medications, non-invasive procedures, and surgical options. Our goal is to provide you with a personalized plan that assists you in achieving your weight loss goals. For more information on our weight loss services, please click here. (Insert hyperlink here to weight loss landing page).

We offer a wide array of skincare services at the Caudle Center. We have a board certified aesthetician that provides a variety of skincare services including facials, chemical peels, microdermabrasion, and more. We also offer everything from skincare products, neurotoxins, dermal fillers, radiofrequency treatments, intense pulsed light therapy procedures, facial resurfacing, and many more procedures to meet all of your skincare needs. Contact us today at 423-926-2400 for a consultation.


Food Choices

Our food choices may play a significant role in health issues affecting women, including menstruation and menopause, pregnancy and breastfeeding, and risk for certain types of cancer.

Besides skin cancer, breast cancer is the most common cancer among American women. To demonstrate how dramatically lifestyle choices may impact breast cancer risk, researchers followed about 30,000 postmenopausal women with no history of breast cancer for about seven years. Limiting alcohol, eating mostly plant foods, and maintaining a normal body weight was associated with a 62 percent lower risk of breast cancer.

Remarkably, eating a plant-based diet along with walking every day may improve our cancer defenses within just two weeks. Researchers attributed this effect to a decrease in levels of a cancer-promoting growth hormone called IGF-1, likely due to the reduced intake of animal (meat, egg white, and dairy) protein.

What about carcinogens in cooked meat? Women who eat more grilled, barbecued, or smoked meats over their lifetimes may have as much as 47 percent higher odds of breast cancer.

Consumption of animal-based products have also been implicated in earlier onset of puberty for girls, which had begun when girls were on average 16 or 17 until the 20th century, but now we see significant numbers of girls starting to grow breasts before they’re 8 years old, and increased risk of infertility.

Polycystic ovary syndrome (PCOS), potentially the most common hormonal abnormality among young women in the United States and a common cause of infertility, menstrual dysfunction, and excess facial and body hair—may also be affected by diet. Advanced glycation end products (AGEs) may contribute to the cause of PCOS and infertility. So, in addition to not smoking, we should decrease consumption of foods high in protein and fat, and rich in AGEs, such as meat, cheese, and egg yolks, and increase intake of foods high in antioxidants, such as berries, herbs, and spices.

Plant-based diets appear to offer relief from a variety of menstrual symptoms, including bloating and breast pain (cyclical mastalgia), and women suffering with dysmenorrhea—painful, crampy periods—who switch to a plant-based diet experience significant relief in menstrual pain intensity and duration.

Thyroid

The thyroid is a gland located in the lower, front portion of the neck. The thyroid gland itself is controlled by another gland, pituitary, located in the brain. The thyroid gland secretes two thyroid hormones, mostly T4 (thyroxine) but also some T3. T3 is the active hormone that is used at the cellular level. T4 has to be converted first into T3. These hormones regulate the many expressions of the body’s metabolism.

The thyroid regulates many things in the body including temperature, metabolism, cerebral function, and energy levels. It also increases fat breakdown resulting in weight loss as well as lowering cholesterol. When functioning normally, it protects against cardiovascular disease, cognitive impairment, fatigue, weight gain, and memory loss.

Since T3 is so widely used in the body there are over 200 symptoms related to thyroid deficiency including: weakness, coldness, tiresome, fatigue, thin hair, dry skin, thin nails, weight gain, increased body fat, loss of energy, loss of motivation, loss of cognition, loss of memory, mood disturbances, and a poor overall sense of well-being.

The symptoms of low thyroid vary widely but are notoriously for being nonspecific and mimicking many of the normal changes of aging. Frequently thyroid hormone levels fall slowly over time so the symptoms of low thyroid are slow in onset and insidious. Many times we attribute our symptoms to aging when in fact something can be done about it!

In order to customize thyroid replacement specific to you, we will measure your current level of thyroid hormones and will review your symptoms of possible thyroid depletion. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend over time your thyroid levels with your response to treatment by following your symptoms of low thyroid until you are in proper balance.

We will continue to monitor you to minimize any possible side-effects from too little or too much thyroid and monitor you for any other related medical problems.

DHEA

Dehydroepiandrosterone (DHEA) is a hormone secreted primarily by the adrenal glands. DHEA itself is not felt to be active but it is a precursor to the active androgen hormones, testosterone and dihydrotestosterone. It results in a shift of a catabolic state to an anabolic or protein building state. By doing this it reduces cardiovascular risks by increasing lipolysis (decrease visceral fat). Studies suggest that it helps to stimulate the immune system, restore sexual vitality improves moods, decreases cholesterol and body fat. DHEA improves memory, increases energy, and is thought to have anti-cancer properties by enhancing the immune system. Declines in DHEA may contribute to loss of sleep, osteoporosis, and atherosclerosis.

Studies suggest that optimal DHEA levels reduce insulin requirement, plays a role in restoring immunity, preventing osteoporosis, increasing bone density, prevent diabetes, prevent heart disease, decreases visceral fat, it can improve mood and a sense of well-being, improves energy and memory.

Most people do not need supplement DHEA. In order to properly screen for potential benefit from DHEA replacement, we will measure your current level of DHEA hormones and will review your overall symptoms of health. This will include a complete history and physical examination. After we review the benefits and any possible side effects of treatment and if you are agreeable, we will begin treatment. Any other medications or medical problems will be taken into consideration. We will trend over time your DHEA levels with your response to treatment by following your symptoms until you are in proper balance.

We will continue to monitor you to minimize any possible side-effects from too little or too much thyroid and monitor you for any other related medical problems.

Vitamin D

Melatonin